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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - PCV 34 but no regeneration
| Hi all, my Sheltie Taylor is 4.5 years old, female, and has been climbing back upwards since beginning treatment for AIHA in November. Her PCV has climbed to 34 now which is her highest, but at this time it does not look like she is regenerating (based on reticulocyte test). However, in past tests, her results have shown regeneration taking place. She is currently on Prednisone, Aziothiprene, & Denamarin (for liver). The vet wants to phase out the Pred and Azio and add Cyclosporine today. Does anyone know of any meds/natural remedies that boosted your dogs' regeneration? I'm not sure if she is classified as non-regenerative if she has done it before?? Was anyone able to have the thyroid tested while on meds like Prednisone, Azio, etc.?? I am thinking that thyroid supplementation will help her regenerate. Any advice you have would be wonderful. She is seeming pretty normal right now, but we are worried what may happen if her adult cells die and are not replaced with new ones. From you all's experience, did Cyclosporine help with regeneration of new cells? Thanks to all. |
| Jessica Texas |
| Hi Jessica. If this were me I'd add the cyclosporine and then AFTER at least a week I'd phase out ONLY the azathioprine and leave the prednisone. Azathioprine is a known bone marrow depressor so eliminating htis might be wise. It's really difficult for regular vets to check the thyroid while on these drugs cause they just don't know how to compensate for the variences. Also, most vets only give the T4 which really doesn't tell enough of a picture. I'd recommend sending a blood sample to either Dr. Dodds at hemolife OR Michigan State University. Both these places do breed specific testing BUT Dr. Dodds would be by far the better option. I was just saying in another post that you can get a FULL thyroid panel done, FULL CBC, FULL chemical analysis, RBC morphology AND most importantly...her very own analysis and recommendations!! Well worth every single penny!!! She's the one that helped me to turn Tessy around ...as well as countless others here!! she's just so far ahead of the game compared to regular vets and even specialists!!! ALSO, IMO, I think that you should retest the blood BEFORE changing or adding any drugs. 34% is really getting close to normal levels and without knowing exactly what the blood is doing (rbc morphology) it's just too difficult to speculate. Watch the PCV to make sure it doesn't go down. If it doesn't then I wouldn't change anything regardless the retic count...except for maybe reducing the azathioprine. In cases like these it wouldbe recommended to get full CBC's instead of the spun PCV if you can afford the difference. Tell them you want a CBC (complete blood count) instead of a PCV (packed cell volume). Well worth the difference in price. Pet tinic would be recommended as an aid to stimulating the blood production as would a thyroid supplement...making thyroid testing of uber importance! Good luck and keep us posted. My thoughts and prayers are with you both. Johnny & Tessy |
| Johnny |
| Thank you so much Johnny & Tessy for your help!!! I actually just spoke with my vet to get a history of Taylor's regeneration (reticulocyte counts) since we began treatment around Nov. 1. Her PCV on the other hand has slowly climbed from 10% (with a transfusion shortly after) to 34% where it is now. We are going to re-test this on Monday. Ok, so for her reticulocyte history, in terms of the absolute count, at her very first appt with PCV of 10%, absolute reticulocyte count was 3,220. Over her past 3 months of appointments, the reticulocyte pattern is as follows: it jumped to 159,000 shortly after treatment began, then crashed to 23,310 a week later, then shortly after rose to 65,000, then crashed to 18,000 about a month later, then rose to 53,200 about a month later, and most recently about a month later crashed REALLY low to 4,400. This is why I am very worried. I questioned the thyroid and he said he would usually test first but I told him what I'd read online and he said yes we can start a clinical trial with Soloxine. So, at this point, we should start Cyclosporine tonight, and hopefully Soloxine within a day or two, along with Prednisone, Aziothiprene, Denamarin, and yes she currently takes Pet Tinic also and Pepcid A/C. Vet said we will run another reticulocyte test 10-14 days after the start of Cyclosporine. Does 100 mg sound correct for Taylor (she weighs 28 lbs)? I know high doses used starting out. Yes at this point I am worried that the Aziothiprene is suppressing her regeneration and would definitely like to phase that out asap. In terms of PCV vs. reticulocyte count, is one of more importance in terms of critical condition? She is looking and acting basically normal I would say and her PCV is 34% but her reticulocyte count (absolute) is 4,400 so I am totally torn and confused at this. Any feedback from anyone on these conditions and the meds would be wonderful. This is the BEST AIHA discussion board I have come across. |
| Jessica Texas |
| For the thyroid supplement the recommended starting dosage is 0.1mg for every 10 pounds of weight. So you'd be looking at around 0.3mg given twice daily 12 hrs apart. The cyclosporine dosage is close to right. The starting dose is usually 10mg/kg so for you would be closer to 150mg daily....being 75mg in the morn and then 75mg in the evening 12 hrs AFTER. BUT, since Taylor is already on immune suppressors the 100mg daily should be sufficient. Just get the 50mg caps so you can give it twice daily. I still think your absolute best bet would be to send blood to Hemolife! Keep us posted. Johnny & Tessy |
| Johnny |
| Jessica, I am sorry to read about Taylor. My dog Chance had a similar serious case of non-regenerative anemia in 2007. He survived and lived for another 3 years. I am emailing you a protocol that I used to do this that was provided to me by Dr. Jean Dodds. Watch your email to make sure this doesn't go to spam. There can be a number of reasons for a failure to produce reticulocytes. In Chance's case he was probably destroying the precursor cells in the bone marrow that are made into red and white cells and the platelets. In some rare cases, it can be a kind of bone marrow cancer. But it seems that many of these dogs with this non-regenerative state are experiencing this autoimmune condition. Another cause for apparent low reticulocytes in general circulation can be maturation problems. In other words, the new cells are made in the marrow but they are not robust and fail to mature to full size. There is often a nutritional component to this. This can be a failure to absorb and utilize nutrients in the small intestine that are vital to the production of these cells. Another condition that can contribute to poor maturation is something called portosystemic shunt or liver shunt. The liver stores many important nutrients for manufacture of blood. If the liver is bypassed in this way, those nutrients are not available. Dietary supplementation is not a successful in this case. Along with these other conditions is the contribution the thyroid makes to blood production. Many dogs develop an autoimmune condition that leads to the destruction of the thyroid gland. Hypothyroidism can contribute to the non-regenerative state as well. The kidneys are also directly responsible for stimulating the bone marrow to make blood. If there are kidney issues then they may not produce enough of the hormone erythropoietin. Many of these causes are rare. But I mention them because in your case the attending vet should give thought to each one as a possibility. I am sad to say that one member of our forum had a dog that had a prolonged case of non-regenerative anemia. The vets tried all sorts of things, but in the end it was discovered that the dog had a serious liver shunt. But I also want to tell you that there is great hope. My dog Chance is the success story you need to think about as you work through this. It is possible to overcome this. Please read the protocol I have sent you and share it with your vet. my best patrice |
| Patrice NYS |
This thread was discussed on 18/02/2011
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